Filed under: FDA

Is there any harm in taking dietary supplements if you use medications?

Dietary supplements and medications (prescription or over-the-counter) can be a risky combination. That’s because many dietary supplement ingredients, especially herbs and botanicals, can interact with drugs (such as ones to treat blood pressure, diabetes, depression, and anxiety) or even other dietary supplements. Interactions between drugs and supplements can result in either an increase or decrease in the effectiveness of your medications. In other words, you could be getting too much or too little of the medications that you need, which can be dangerous to your health. If you’re taking or plan to take a dietary supplement, inform your healthcare provider to make sure it’s safe to use with your medications.

Learn more about how supplements can change the effectiveness of your medications and know when drug-supplement interactions are especially important by using this interactive web resource from the National Center for Complementary and Integrative Health (NCCIH). And for information about many known interactions between dietary supplement ingredients and medications, as well as other dietary supplement ingredients, visit the Natural Medicines Comprehensive Database (NMCD).

Dietary supplements don’t require approval by the Food and Drug Administration (FDA) before being put on the market. That means unless a product has been tested in a laboratory, there’s no way to know its true contents, including potentially problematic ingredients and possibly even ones not listed on the label. So how can you tell if a product really contains what it says on the Supplement Facts panel? Check the product label to see if it carries a seal from an independent, third-party organization. For more information and examples of third-party organizations, visit the OPSS FAQ about third-party certification.

FDA continues to identify over-the-counter products, including dietary supplements, containing hidden active ingredients. Could yours be one of them?

Since July 2016, the Food and Drug Administration (FDA) has released over 25 Public Notifications about individual supplement products marketed for sexual enhancement and weight loss that contain hidden active ingredients. Through laboratory testing, these products were found to contain drugs and controlled substances—ingredients that pose health and readiness risks. For a list of these Public Notifications, visit FDA’s Tainted Sexual Enhancement Products and Tainted Weight Loss Products.

The most common types of products found to contain “undeclared” ingredients (that is, substances not listed on the label) are those marketed for weight loss, sexual enhancement, and bodybuilding. Dietary supplements don’t require FDA approval before being put on the market, and there is no way to know the contents of a product without laboratory testing. So if you’re considering a dietary supplement, check the label to see if the product has been evaluated by an independent third-party organization.

Some dietary supplement products contain ingredients that just shouldn’t be there. Here’s what to look out for.

In recent years, the Food and Drug Administration (FDA) has taken action against dietary supplement companies for selling products with ingredients that put them in a category of being “adulterated” or “misbranded.” Examples of these ingredients include Acacia rigidula, BMPEA, DMAA, DMBA, ephedra, methylsynephrine, and picamilon. Such ingredients have been determined to be unsafe, lack evidence of safety, don’t meet the definition of a dietary ingredient, or combinations of these issues. Some are even used as drugs in other countries.

Although these ingredients are not allowed in dietary supplements, you might still find them in some products, so always read product labels carefully. Service members especially take note! Since FDA has declared the ingredients listed above (and others) to be “illegal” or “not allowed” in dietary supplements for one reason or another, commands have restricted their use by military members. For more information about FDA’s role in regulating dietary supplement products and ingredients, visit FDA’s web page.

Another ingredient that has been showing up in dietary supplement products recently is Acadia rigidula. FDA recently declared that it is not acceptable in such products because it falls in the class known as a “new dietary ingredient.” A. rigidula is just the latest in a series of ingredients FDA has disallowed for this reason. Others include DMAA, DMBA, BMPEA, and aegeline. Visit the Operation Supplement Safety (OPSS) FAQ about Acacia rigidula to learn more, and explore the OPSS FAQs about ingredients to learn about others not permitted in dietary supplement products. especially BMPEA, which has been associated with A. rigidula.

Do you know if a dietary supplement’s advertising promises more than the product can actually deliver? The Federal Trade Commission can help.

HPRC has often posted information about FDA and safety surrounding the topic of dietary supplements, but there’s another Federal agency watchdogging the supplements industry: the Federal Trade Commission (FTC). One of FTC’s primary missions is to protect consumers from unfair or deceptive business practices. That includes misleading or false advertising and claims. FTC advertising law states that all claims made by dietary supplement manufacturers and distributors must be substantiated before they are made. Unfortunately, not all supplement manufacturers follow the rules, so check out FTC’s new infographic to learn more about deciphering dietary supplement claims.

Just as FDA has a reporting system for adverse effects associated with dietary supplements, FTC has a consumer complaint process that you can use. For information about how to report a problem, visit this FTC web page.

FDA issued warning letters to 5 distributors of powdered pure caffeine and continues to warn consumers against using these products.

The Food and Drug Administration (FDA) is again warning about the dangers of powdered pure caffeine. At least 2 deaths (both teenagers) were associated with it in 2014, yet it continues to be sold, primarily in bulk online. FDA recently sent warning letters to 5 distributors of pure powdered caffeine, warning about potential serious health effects. FDA notes that it’s difficult to determine the difference between a safe amount and a toxic amount but that one teaspoon is roughly equivalent to 28 cups of coffee. For more information, read FDA’s update and HPRC’s 2014 article.

BMPEA is an unapproved amphetamine-like substance that has been appearing in some dietary supplement products. BMPEA (also known as β-methylphenylethylamine, R-beta methylphenylethylamine, beta-methylphenethylamine, and others) was first made in the 1930s as a possible replacement to amphetamine (a central nervous system stimulant), although it never became a drug because human studies on safety were not performed.

The Food and Drug Administration (FDA) tested 21 supplement products with the ingredient Acacia rigidula listed on the label and found that 9 of the 21 products were found to contain BMPEA, which is not derived from the plant Acacia rigidula. Some dietary supplement products actually list BMPEA on their labels. FDA recently issued a warning stating, “…BMPEA does not meet the statutory definition of a dietary ingredient.” Therefore, dietary supplement products with BMPEA are misbranded and cannot be sold as dietary supplements.

If you read product labels, you know there are numerous “mystery” ingredients in many foods. This FDA brochure takes some of the mystery away.

Food and color additives exist in many of the foods that we eat. They are used to improve safety and freshness, maintain the nutritional value of foods, and improve texture and appearance. The Food and Drug Administration (FDA) has put together a helpful brochure reviewing how additives are approved for foods, types of food ingredients, and a description of food and color additives.

The Food and Drug Administration (FDA) is warning consumers about powdered pure caffeine, particularly as sold in bulk on the Internet. At least one death has been associated with the use of such products, and FDA advises consumers about the potency of powdered pure caffeine. See FDA’s Consumer Advice, which includes information about how to report an adverse event.

According to this consumer resource from FDA, you should limit your caffeine intake to just 100–200 mg per day (about 5–10 ounces of coffee). Taking large doses of caffeine—roughly 400–500 mg—at one time can result in a serious condition known as “caffeine intoxication.” Some symptoms of caffeine intoxication are minor and include nausea, vomiting, agitation, nervousness, or headache. Other symptoms can be more life-threatening, such as rapid heartbeat, electrolyte imbalance, very high blood sugar, or high levels of acid in the blood, which can cause seizures. See the OPSS FAQ to help you avoid hidden sources of caffeine.

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